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Govind Rao

Council of Canadians opposes "competitive bidding" for home care services in Nova Scoti... - 0 views

canadians.org/...home-care-services-nova-scotia

from heather NS ally home care privatization

shared by Govind Rao on 20 Apr 15 - No Cached
  • April 17, 2015
  • The Council of Canadians is opposed to "competitive bidding" for home care and support services in Nova Scotia. In an opinion piece published in the Chronicle Herald, Halifax-based Council of Canadians organizer Angela Giles and allies note, "Health and Wellness Minister Leo Glavine recently announced plans to seriously consider opening home care and support services to competitive bidding. This would allow private, for-profit corporations to bid on contracts currently provided by government and not-for-profit agencies. This competitive bidding process will award home-care contracts based on the lowest bid, not on who will provide the best quality of care. To date, Mr. Glavine has refused to hold consultations or allow for public input."
Irene Jansen

After all the months of debate, does the health bill actually stack up in law? | Left F... - 1 views

www.leftfootforward.org/...loucestershire-legal-challenge

nhs campaign social care bill trade competition

shared by Irene Jansen on 05 Apr 12 - No Cached
  • a test case campaign to challenge the establishment of a social enterprise – namely Gloucestershire Care Services Community Interest Company – has been fought and won by 76 year old Michael Lloyd, working with ‘a cross party coalition of anti-cuts campaigners’.
  • They argued the local PCT had acted unlawfully in planning to hand over management of nine county hospitals and 3,000 community health staff in what would have been the biggest planned transfer (so far) to a social enterprise in the country.
  • the Lansley edict of July 2011, that £1 billion of NHS services would be opened up to competition.
  • ...12 more annotations...
  • NHS Gloucestershire had not put this work out to tender, nor explored in-house/NHS options which, campaigners say, would have made tendering unnecessary in the first place
  • only reduced staff terms and conditions upon the service leaving the NHS, would offer a key cost saving
  • any cost gain would be significantly reduced by the new social enterprise VAT bill
  • which would not have applied under the internal NHS model
  • “The South West is leading the charge to social enterprise – with 15,000 of 25,000 staff in the UK, likely to be affected by reduced terms and conditions, coming from the region.”
  • Lansley’s ‘do it quick never mind the risk’ stick, the underbelly of which we highlighted last week
  • the Hull example, where aside from the one-off transfer costs, when NHS Hull morphed into a social enterprise, they found the need to build an entire new wing to house the extra administrative staff – those who had been ‘cut loose’ from the NHS – because the new enterprises are required to have their own duplicate back office functions where previously they could draw on NHS central resources.
  • as long as matters are kept within the NHS there is no contract on which EU procurement law ‘actually bites’,
  • this result at the High Court also begs the question: now the Bill is passed, exactly how far are our current NHS providers obliged to put existing services out to competitive tender?
  • The Gloucestershire example seems to demonstrate there are more angles to take than even the government themselves had considered in their own search for profiteering loopholes.
  • Will it really be possible, as Professor Allyson Pollock advises, to “stop all commercial contracts”, citing the danger of the government continuing to claim commercial confidentiality trumps the public’s right to know about contract decisions.
  • The PCT is legally obliged to: 1). Involve public; 2). Consider NHS options; 3). Invite ‘expressions of interest’ (in bidding) – crucially, not the same as ‘inviting bids’; before 4). Deciding what to do, which may or may not involve ‘inviting bids’, depending on whether NHS bodies come forward, which would mean they didn’t need to go to stage of open tender, i.e. inviting bids.
Govind Rao

Up to 20 private hospitals in the UK may have to be sold to increase competition | BMJ - 0 views

www.bmj.com/bmj.f5347

from heather UK privatization p3

shared by Govind Rao on 04 Sep 13 - No Cached
  • Up to 20 private hospitals in the UK may have to be sold to increase competition BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f5347 (Published 30 August 2013) Cite this as: BMJ 2013;347:f5347
  • Matthew Limb
  • Many patients pay too much for private health treatment because of the “market power” exercised by big hospital groups, a major investigation by the Competition Commission has found.1
  • ...1 more annotation...
  • The commission recommended that up to 20 private hospitals in 11 UK locations should be sold off to other operators to widen competition.
Irene Jansen

Defending Public Healthcare: If contracting out works, why do they keep suspending it? ... - 0 views

ochuleftwords.blogspot.ca/...ing-out-works-why-do-they.html

ontario home care competitive bidding

shared by Irene Jansen on 18 May 12 - No Cached
  • The Ontario government's system of contracting out for home care services (the so-called "competitive bidding" system) has been put on hold for another two years, it seems. 
  • Following a meeting with government officials, various bosses and mucky-mucks in the Ontario home care industry have come out and  declared the following:  
  • As proposed in a first step in a phased transition, new contracts would be developed and then negotiated with existing service providers outside of a competitive bidding process, effective October 1st, 2012 for the subsequent two year period (2014). These new contracts would reflect the realities of our environment; quality imperatives, fiscal restraint, greater focus on client-centred care and defined client populations, and the requirement to collaborate and implement change over a short period of time.   In subsequent phases it is proposed that all home care contracts will be renewed based on clear performance metrics related to transition, quality improvement, client satisfaction, innovation and value for money. Opportunities for new entrants to obtain contracts would be provided through joint ventures, subcontracts or other arrangements.
  • ...2 more annotations...
  • This is just the latest suspension of compulsory contracting.
  •  In the face of community opposition, the government has been forced to suspend the process for years.
Irene Jansen

BBC News - Private health sector may distort competition, OFT says - 0 views

www.bbc.co.uk/...business-16082054

privatization nhs

shared by Irene Jansen on 23 Jan 12 - No Cached
  • The Office of Fair Trading has said it is minded to refer the UK's £5bn private healthcare sector to the Competition Commission.
  • In a provisional report, the OFT said it had found issues that could "prevent, restrict or distort competition" in the market.
  • The OFT will make a final ruling next year after further consultation.
  • ...2 more annotations...
  • the OFT said it found three key issues that needed further investigation: There is a lack of easily comparable information available to patients, GPs or health insurance providers on the quality and costs of private healthcare services; There are only a limited number of significant private healthcare providers and of larger health insurance providers at a national level; A number of features of the private healthcare market combine to create significant barriers to new competitors entering and being able to offer private patients greater choice.
  • Suppliers have broadly welcomed the review.
Irene Jansen

The Mowat Centre for Policy Innovation. A TRANSFORMATIVE BLUEPRINT FOR REDUCED COSTS, I... - 0 views

www.mowatcentre.ca/press-releases.php

abf private clinics competitive bidding it

shared by Irene Jansen on 23 Jan 12 - No Cached
  • the Mowat Centre at the University of Toronto has released a blueprint for transformative changes to the healthcare system
  • The report recommends five significant changes: • Modernize the organization of hospitals, with academic centres focused on diagnostic work-ups, specialty clinics providing routine procedures efficiently and accessibly, and networks of care that monitor patient well-being • Embrace the ‘‘virtualization’ of many existing services that are currently only delivered in person • Widely deploy digitization by reforming agencies so that they can respond to technological change more quickly and by providing more IT funding directly to providers • Encourage organic governance evolution without undertaking wholesale restructuring, and • Reform the way health services are purchased.
  • The report is part of the Shifting Gears Series on the transformation of public services and was supported financially by KPMG.
  • ...1 more annotation...
  • To read the full report, please click here
  • Irene Jansen on 23 Jan 12
     
    National Post coverage: Innovations seen as lowering health costs. National Post. Nov 1 2011 Tom Blackwell  Provinces must find ways to profit from efficiencies - like the steadily falling cost of cataract surgery. While favouring marketstyle competition, the academics draw the line at allowing a private tier of medicine or even expanding the role of privatehealth operators in the public system. Set up more stand-alone clinics, like those that do cataract surgeries. Move away from block funding of hospitals (an institution is paid a lump sum every year to cover most services) toward payments tied to treatment of individual patients. Cap increases in physicians' fees, link fees more closely to changes in technology and hold auctions in the public system, to get the best deal for providing some procedures. Experience suggests doctors may not welcome some of their proposals. In 2002, a $4-million study funded by the Ontario government - and initially supported by the Ontario Medical Association - recommended an overhaul of the fee schedule to better reflect the up-to-date value of each doctor service. It would have meant income drops for some specialists - such as the opthalmologists who do cataracts - while others would earn more. See also: Health Care reform? Despite frightful predictions of ever-rising costs, governments can reap savings by managing change Toronto Star Nov 1 2011  Opinion  Will Falk
Irene Jansen

Flaherty's health spending limit is the easy first step - 0 views

www.ottawacitizen.com/...story.html

accord sustainability privatization europe

shared by Irene Jansen on 23 Jan 12 - No Cached
  • surely the provinces can't be surprised that the feds won't keep putting money into health care at more than double the rate of inflation. Most are already taking the same kinds of responsible steps themselves
  • The federal contribution will be capped at the rate of increase in the gross domestic product. Economic growth is a reasonable proxy for the increase in federal tax revenues, but Flaherty will need to explain what happens if the country enters another recession. It's one thing to limit the rate of increase in health-care spending, quite another to cut the actual dollar amount.
  • Flaherty's plan to limit health funding increases is a bit of a blunt tool, but it does create a pressure on government to be responsible with our money.
  • ...6 more annotations...
  • cataract surgery has become much quicker and more efficient, but the prices haven't gone down as a result because government has done nothing
    • Irene Jansen
      Irene Jansen on 23 Jan 12
       
      because provinces haven't reduced the fee-for-service rate to reflect physicians' reduced costs
  • Statistics from the Organization for Economic Co-operation and Development show that Canada is one of the highest health-care spenders, but has below average numbers of doctors, nurses, hospital beds, CT scanners and MRIs. Another study, the euro-Canada Health Consumer Index, found that Canada finished in the bottom third in a "bang for the buck" comparison with European countries.
  • choice and competition are what drives the more effective European systems
  • the act that governs medicare stifles innovation and competition, except in Quebec, where the federal government turns a blind eye to innovation and private sector involvement
  • Flaherty's plan to limit spending increases is sensible and necessary, but it requires no political courage. The much more important move would be to allow provinces to experiment with European ideas and introduce more innovation and competition
  • Randall Denley is a member of the Citizen's editorial board.
Irene Jansen

Competition-Based Reform of the National Health Service in England: A One-Way Street? b... - 0 views

papers.ssrn.com/...papers.cfm

nhs privatization trade scotland excellent

shared by Irene Jansen on 21 Sep 12 - No Cached
  • The Conservative-led government in the United Kingdom is embarking on massive changes to the National Health Service in England. These changes will create a competitive market in both purchasing and provision. Although the opposition Labour Party has stated its intention to repeal the legislation when it regains power, this may be difficult because of provisions of competition law derived from international treaties. Yet there is an alternative, illustrated by the decision of the devolved Scottish government to rejectcompetitive markets in health care.
Govind Rao

Home care competitive bidding invites for-profit companies | Halifax Media Co-op - 0 views

halifax.mediacoop.ca/...33519

from heather home care union coalition campaign NS

shared by Govind Rao on 06 May 15 - No Cached
  • Quality of care will suffer and workers will leave, Town Hall panel predicts
  • by Robert Devet
  • KJIPUKTUK, (HALIFAX) - Last night's town hall meeting in Halifax, organized by the Nova Scotia Health Care Coalition, tackled the privatization of home care.
  • ...1 more annotation...
  • In November of last year Leo Glavine, Minister of Health and Wellness, first talked about his intention to move to a competitive and profit-driven home care model. Currently home care services are mostly provided by nurses and home support workers employed by not-for-profit organizations such as the Victoria Order of Nurses (VON).
Doug Allan

Scarborough's two hospital systems to study merger - Infomart - 0 views

www.fpinfomart.ca/...171390451

restructuring scarborough

shared by Doug Allan on 21 Jun 13 - No Cached
  • Scarborough's two hospitals have agreed to start studying a full merger.
  • The Central East Local Health Integration Network, a regional overseer expected to approve the study on Monday, ordered the hospitals in March to create an "integration plan" between TSH General and Birchmount campuses and RVHS Centenary.
  • "Right away it was like silos fell down between the two hospitals," said Lyn McDonell, a TSH board member on the committee.
  • ...9 more annotations...
  • "Everything's on the table," said TSH CEO Robert Biron, who argued Scarborough's hospitals have suffered a lack of operating and capital funds because they are split, an arrangement he called "to some degree dysfunctional."
  • The TSH board expected to hear the report of an expert panel on two proposals the LHIN said required more study, the elimination of the birthing centre at the General and a division of programs turning the Birchmount into a centre for day surgery and the General into the facility for operations requiring overnight stays.
  • "We felt strongly that merger seemed to be the (option) that had the most potential."
  • As the province forces hospitals into "a more competitive model," those in Scarborough need a way to "obtain our fair share," he said.
  • We're much better positioned if we do that together."
  • "The days of hospitals doing everything for everybody" are changing, said Dr. Robert Ting, the group's president. "We have to decide what our community needs and focus on certain areas."
  • So much enthusiasm for a merger was expressed, Warren Law, a TSH board member who is not on the ILC, cautioned colleagues the appropriate time to make the case was "down the road."
  • Biron insisted the ILC is "starting from a blank slate" and no decision to merge had been made.
  • In 2011, Dr. John Wright, the former TSH CEO, initiated study of a merger between TSH and Toronto East General Hospital in East York, but the work was shelved last year after objections from medical staffs of both hospitals, residents and the LHIN, which noted the East General was outside its jurisdiction.
  • Doug Allan on 21 Jun 13
     
    As the province forces hospitals into "a more competitive model," those in Scarborough need a way to "obtain our fair share," he said. "We're much better positioned if we do that together."
Govind Rao

Medicare's safety valves - Infomart - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246200|ntnp|20150323|216966837

from heather medicare private clinics privatization

shared by Govind Rao on 23 Mar 15 - No Cached
  • National Post Mon Mar 23 2015
  • When government monopolies fail to provide the level of service citizens expect, or when excessive regulations on an industry limits competition and drives up prices, people often seek a market-oriented solution that will provide the services they want at a price they are willing to pay. Uber offers a great example of how people are using technology to bypass the government's taxi oligopoly in many major cities. Although there is not yet an app that would allow Canadians to get a colonoscopy from a private practitioner, people in this country have, for decades, travelled abroad to bypass the long wait times that are endemic to the Canadian health-care system.
  • How many people are seeking medical treatment abroad? A new Fraser Institute study surveyed Canadian physicians to find out how many of their patients went out of country in search of timely care. It estimates that 52,513 people received medical care abroad in 2014, although the authors note that this estimate does not take into account those who left the country without first consulting their doctor here at home. And the number of Canadian medical tourists is growing, having risen from 41,838 in 2013. The reason may not be hard to find. A study released last year by the U.S.-based Commonwealth Fund ranked the health-care systems of 11 industrialized countries and placed Canada second to last overall. Interestingly, two countries that have similar systems to ours, the U.K. and Australia, ranked first and fourth respectively.
  • ...4 more annotations...
  • he main difference is that although these countries have universally accessible health-care systems, they also allow people to receive private medical services by paying outof-pocket or purchasing insurance. Their systems result in better overall care, for two main reasons. First, competition from private hospitals and medical practices provides an incentive for the public system to improve. As the C.D. Howe Institute's Åke Blomqvist and Colin Busby argue in a policy paper released last month, in Canada, "lack of competition between provincial health insurance plans and privately financed medicine has lessened the pressure on publicsector managers and politicians to improve an inadequately performing system."
  • Having a parallel private alternative also helps reduce wait times in the public system. Last year, Canadians waited an average of 9.8 weeks to receive medically necessary treatments after seeing a specialist - three weeks longer than what most doctors consider to be "reasonable." In the Commonwealth Fund study, Canada ranked dead last in terms of "timeliness of care," while the U.K. came in third and Australia sixth. (The U.K. and Australia also ranked first and second respectively in terms of quality of care.) Fears of a mass migration of doctors into the private system are easily answered. In the U.K., doctors trained in public universities are required to work in the National Health Service (the public system) for at least two years before they can move into the private system. Doctors who receive NHS funding are also allowed to set up parallel private practices, but must work 40 hours a week for the NHS.
  • Fortunately, Canadian provinces have quite a bit of leeway to experiment with allowing more privately delivered medical services. As Mssrs. Blomqvist and Busby argue, "Although this is not widely understood, the [Canada Health Act] does not rule out transactions in which providers are paid privately for their services. There is also no prohibition on private insurance that covers the same services as those under the public plans, provided these services are supplied entirely independent of publicly funded services." Indeed, all that is needed is for provincial governments to take the initiative and remove some of their restrictions on private health services.
  • The health-care debate in this country has traditionally focused on comparing our system with that of the United States. Yet the truth is that we have much more in common with European and other industrialized countries. As many of these countries have shown us, it is possible to provide world-class health care that is accessible to all people, while allowing those who choose to pay for private services to do so here at home, rather than travelling overseas.
Govind Rao

Home care rethink is needed; Cost-cutting measures at CCACs have fragmented and confuse... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|hbsp|20150321|216869446

from heather home care Ontario cuts

shared by Govind Rao on 23 Mar 15 - No Cached
  • Hamilton Spectator Sat Mar 21 2015
  • Home care in Ontario has been a controversial subject for decades. In 1995, the Mike Harris government implemented Community Care Access Centres or CCACs, and a managed competition model for service providers. This system changed the face of home care, but did it cause more harm than good? In the 1980s and 1990s, political parties unanimously agreed that reform was needed, as there was no formal home care system and provincial government spending in health care was too high. Each party proposed a new home care model, and after their election the Harris government passed the Home Care and Community Services Act.
  • CCACs were introduced to better help individuals live independently at home and to provide information about care options through community support agencies. However, the introduction of a competitive procurement process was driven by an effort to cut costs. The managed competition model allowed CCACs to contract out to several different service providers. Long-standing not-for-profit service providers began to be replaced by private, for-profit service providers. Between 1995 and 2001, the for-profit share in Ontario home care rose from 18 per cent to 46 per cent, while the not-for-profit shares dropped by 28 per cent. After a contract with a service provider expires, CCACs are able to hire a new set of service providers.
healthcare88

The topsy-turvy world of hospital budgets; MUHC's plight shows activity-based... - 0 views

www.fpinfomart.ca/doc/doc_display.php?key=pr|246243|mtgz|20161101|259603772

quebec day privatization hospital funding p3

shared by healthcare88 on 01 Nov 16 - No Cached
  • Montreal Gazette Tue Nov 1 2016
  • Imagine a business providing a service so popular that demand is 30 per cent higher than anticipated. That would be good news, right? Admittedly, there might be an adjustment period as more equipment is purchased and additional staffis hired. But still, you would expect more demand to be a positive thing. Now imagine this business complaining about having too many clients. And not just complaining, but reducing the use of new equipment and firing staff. Sounds crazy? Welcome to the topsy-turvy world of public health care in Canada, where patients are a source of additional expenses for a hospital instead of being a source of revenue.
  • The latest instance of this madness is the Quebec government telling the McGill University Health Centre (MUHC) that it is taking on too many cancer and emergency-room patients, according to a report in Monday's Gazette. In particular, ER admissions at the new superhospital that opened in April 2015 are 30 per cent higher than expected. The government is refusing to fund these "volume overruns," with the result being that the MUHC will have a $10-million shortfall for this fiscal year. The MUHC is apparently responding by mothballing some cutting-edge medical equipment, closing new operating rooms, postponing elective surgeries, and possibly cutting 750 full-time and part-time jobs.
  • ...5 more annotations...
  • The main reason for these counter-intuitive reactions to increased demand is the way hospitals are funded. As in most of the rest of Canada, hospitals in Quebec currently receive their funding in the form of global budgets based essentially on the amounts they spent in the past. This kind of lump-sum funding leaves hospitals with a tough choice: Limit admissions or go over budget. There is no incentive for hospital administrators to innovate and become more efficient, since an innovation that reduced expenditures would lead to an equivalent decrease in the hospital's next budget. On the other hand, an innovation allowing wait times to be reduced and more patients to be treated entails increased pressure on the fixed budget.
  • Almost all other industrialized OECD countries fund their hospitals to a large extent based on services rendered. With such activitybased funding, hospitals receive a fixed payment for each medical procedure, adjusted to take into account a series of factors like geographic location and the severity of cases. The more patients a hospital treats, the more funding it receives. Generally speaking, in countries where activity-based funding is widely used, there is more competition between medical facilities and quicker access to care. Health Minister Gaétan Barrette has said that the Quebec government wants to adopt activity-based funding for medical facilities in the health network. This would make a lot more sense than demanding that MUHC doctors refer oncology and ER patients to other hospitals, as the Health Ministry is currently doing.
  • But getting rid of Quebec's anachronistic funding of its hospitals through global budgets, while a step in the right direction, should be accompanied by other, complementary measures such as mandatory quality reporting for hospitals. Giving patients and referring doctors access to the information they need in order to determine the best hospital for each case would allow for some healthy competition, leading to quality improvements throughout the system, as has happened in Germany in recent years.
  • If Brian Day's constitutional challenge now being considered by the British Columbia Supreme Court is successful, two other European measures could also come to Canada: allowing a market for private insurance to develop, and allowing doctors to practise both in the public sector and in the private sector.
  • International experience confirms that the presence of a mixed health care system is not incompatible with health care services that are accessible to all. Indeed, such measures could improve access to health care by encouraging entrepreneurship without undermining the principles of equality and universality that Canadians hold dear. Jasmin Guénette is vice-president of the Montreal Economic Institute.
Irene Jansen

Canadian hospitals turn to Internet to fight emergency room wait times | News | Nationa... - 0 views

news.nationalpost.com/...ight-emergency-room-wait-times

report cards competition abf on hospital alberta

shared by Irene Jansen on 18 Apr 12 - No Cached
  • Patients who log on to the website for Calgary’s hospitals are offered a surprising choice these days: wait times for four emergency departments across the city, posted automatically, 24/7 in “real time.”
  • Kitchener has just become the first in that province to launch its own, enhanced version of the same idea
  • Administrators argue the online information should help patients better decide where to seek out medical aid, spur staff to improve service — and one day even fuel competition between hospitals under new, demand-based funding models.
  • ...6 more annotations...
  • worry about doctors and nurses cutting corners to speed up the Internet clock, and critically ill patients staying clear of their local hospital because of long queues that might not even apply to them.
  • “It leads to the commercialization of the care we provide in emergency departments,” said Dr. Peter Toth, president of the Canadian Association of Emergency Physicians. “It’s a marketing strategy, perhaps. I’m not sure how it really adds to the overall quality of the experience.”
  • Ontario moves to so-called patient-based funding of hospitals, where the province pays hospitals per patient treated, rather than handing over money in annual lump sums.
  • it seems people are still largely choosing the hospital nearest them, not necessarily the one with the shortest wait time.
  • For the staff working in emergency departments, though, the online postings could have unwanted effects, pushing them to give short shrift to some patients to improve the numbers and satisfy superiors, said Dr. Brian Goldman
  • He also worries about patients choosing the hospital that posts the shortest wait times, potentially meaning a longer trip that could prove fatal for someone suffering a heart attack.
Irene Jansen

TheSpec - Home care's 'race to the bottom' - 1 views

www.thespec.com/...home-care-s-race-to-the-bottom

home care on two tier wages union competitive bidding substitution integration

shared by Irene Jansen on 30 Apr 12 - No Cached
  • St. Joseph's Home Care is ready to compete for a flood of opportunity believed to be coming this fall when the province is expected to overhaul how contracts are awarded.
  • The home care agency — run by the same organization as St. Joseph's Hospital and Villa — cut wages by up to 15 per cent in all new contracts it wins.
  • The $13.96 starting hourly rate is now below Hamilton's living wage of $14.95. It takes five years to reach the top rate of $15.31.
  • ...9 more annotations...
  • That's also below the starting wage of $16.07 for personal support workers, dietary aides, health aides and home cleaners.
  • Kim Ciavarella, president of St. Joseph's Home Care. “We introduced this new tier so we'd be able to bid on those contracts. It positions us very nicely.”
  • The 190 workers came close to striking over the two-tier system that sees lower wages go to staff working on any new contracts
  • “We feel it's a race to the bottom,” said Bill Hulme, community care lead for the Service Employees International Union Local 1 Canada, which represents 10,000 home care workers including those at St. Joseph's.
  • The low wages, combined with a lack of job security, have made home care the most unstable sector of the health care system and the hardest in which to retain staff, says Jane Aronson, a home care researcher and director of McMaster's school of social work.
  • “I find it unfathomable that at the same time the provincial and federal governments keep saying home care is very important, it's organized so those who are its front line staff won't have security and in this instance won't even have a living wage,” she said. “It's not a field people can afford to work in very long so we lose people with skills.
  • home care workers make far less than the hourly wage because they're often not paid for their transportation time between clients
  • The province halted competitive bidding in January 2008 to try to resolve some of these issues. It's expected something new will be in place this fall.
  • St. Joseph's Health System is testing what it calls “bundled care,” which involves the province giving a set amount of money to provide diagnostic, hospital, long term care and home care to patients with a co-ordinator overseeing it all and acting as a point of contact.
Irene Jansen

Romney Medicare Plan Draws Stark Contrast With Obama's - NYTimes.com - 0 views

www.nytimes.com/...tark-contrast-with-obamas.html

us federal medicare reforms election

shared by Irene Jansen on 15 May 12 - No Cached
  • President Obama illustrated the importance he is placing on Medicare when, in a slap at Mr. Romney, he vowed this month: “I will never allow Medicare to be turned into a voucher that would end the program as we know it. We’re not going to go back to the days when our citizens spent their golden years at the mercy of private insurance companies.”
  • Under the Romney proposal, the government would contribute a fixed amount of money on behalf of each beneficiary, and future beneficiaries could use the money to buy private insurance or to help pay for traditional Medicare.
  • Mr. Obama is testing new ways of delivering care, notably by encouraging doctors and hospitals to team up to coordinate care, to see if they save money and keep patients healthier. In his latest budget, Mr. Obama proposed $300 billion of further savings in Medicare, most of it from providers.
  • ...2 more annotations...
  • Of the 49 million Medicare beneficiaries, one-fourth already receive comprehensive care through H.M.O.s and other private plans run by companies like UnitedHealth, WellPoint and Humana. The number could rise significantly under Mr. Romney’s proposals.
  • The type of competition Mr. Romney wants to see in Medicare is strikingly similar to the competition that is supposed to drive down commercial insurance prices under Mr. Obama’s health care law. Under the law, people under 65 could choose among competing health plans offered through an insurance exchange in each state, and the government would subsidize premiums for lower- and middle-income people.
Irene Jansen

Senate Social Affairs Committee review of the health accord- Evidence - March 10, 2011 - 0 views

www.parl.gc.ca/...22evb-e.htm

accord senate

shared by Irene Jansen on 23 Jan 12 - No Cached
  • Dr. Jack Kitts, Chair, Health Council of Canada
  • In 2008, we released a progress report on all the commitments in the 2003 Accord on Health Care Renewal, and the 10-year plan to strengthen health care. We found much to celebrate and much that fell short of what could and should have been achieved. This spring, three years later, we will be releasing a follow-up report on five of the health accord commitments.
  • We have made progress on wait times because governments set targets and provided the funding to tackle them. Buoyed by success in the initial five priority areas, governments have moved to address other wait times now. For example, in response to the Patients First review, the Saskatchewan government has promised that by 2014, no patient will wait longer than three months for any surgery. Wait times are a good example that progress can be made and sustained when health care leaders develop an action plan and stick with it.
  • ...97 more annotations...
  • Canada has catching up to do compared to other OECD countries. Canadians have difficulty accessing primary care, particularly after hours and on weekends, and are more likely to use emergency rooms.
  • only 32 per cent of Canadians had access to more than one primary health care provider
  • In Peterborough, Ontario, for example, a region-wide shift to team-based care dropped emergency department visits by 15,000 patients annually and gave 17,000 more access to primary health care.
  • We believe that jurisdictions are now turning the corner on primary health care
  • Sustained federal funding and strong jurisdictional direction will be critical to ensuring that we can accelerate the update of electronic health records across the country.
  • The creation of a national pharmaceutical strategy was a critical part of the 10-year plan. In 2011, today, unfortunately, progress is slow.
  • Your committee has produced landmark reports on the importance of determinants of health and whole-of- government approaches. Likewise, the Health Council of Canada recently issued a report on taking a whole-of- government approach to health promotion.
  • there have also been improvements on our capacity to collect, interpret and use health information
  • Leading up to the next review, governments need to focus on health human resources planning, expanding and integrating home care, improved public reporting, and a continued focus on quality across the entire system.
  • John Wright, President and CEO, Canadian Institute for Health Information
  • While much of the progress since the 10-year plan has been generated by individual jurisdictions, real progress lies in having all governments work together in the interest of all Canadians.
  • the Canada Health Act
  • Since 2008, rather than repeat annual reporting on the whole, the Health Council has delved into specific topic areas under the 2003 accord and the 10-year plan to provide a more thorough analysis and reporting.
  • We have looked at issues around pharmaceuticals, primary health care and wait times. Currently, we are looking at the issues around home care.
  • John Abbott, Chief Executive Officer, Health Council of Canada
  • I have been a practicing physician for 23 years and a CEO for 10 years, and I would say, probably since 2005, people have been starting to get their heads around the fact that this is not sustainable and it is not good quality.
  • Much of the data you hear today is probably 18 months to two years old. It is aggregate data and it is looking at high levels. We need to get down to the health service provider level.
  • The strength of our ability to report is on the data that CIHI and Stats Canada has available, what the research community has completed and what the provinces, territories and Health Canada can provide to us.
  • We have a very good working relationship with the jurisdictions, and that has improved over time.
  • One of the strengths in the country is that at the provincial level we are seeing these quality councils taking on significant roles in their jurisdictions.
  • As I indicated in my remarks, dispute avoidance activity occurs all the time. That is the daily activity of the Canada Health Act division. We are constantly in communication with provinces and territories on issues that come to our attention. They may be raised by the province or territory, they may be raised in the form of a letter to the minister and they may be raised through the media. There are all kinds of occasions where issues come to our attention. As per our normal practice, that leads to a quite extensive interaction with the province or territory concerned. The dispute avoidance part is basically our daily work. There has never actually been a formal panel convened that has led to a report.
  • each year in the Canada Health Act annual report, is a report on deductions that have been made from the Canada Health Transfer payments to provinces in respect of the conditions, particularly those conditions related to extra billing and user fees set out in the act. That is an ongoing activity.
  • there has been progress. In some cases, there has been much more than in others.
  • How many government programs have been created as a result of the accord?
  • The other data set is on bypass surgery that is collected differently in Quebec. We have made great strides collectively, including Quebec, in developing the databases, but it takes longer because of the nature and the way in which they administer their systems.
  • I am a director of the foundation of St. Michael's Hospital in Toronto
  • Not everyone needs to have a family doctor; they need access to a family health team.
  • With all the family doctors we have now after a 47-per-cent-increase in medical school enrolment, we just need to change the way we do it.
  • The family doctors in our hospital feel like second-class citizens, and they should not. Unfortunately, although 25 years ago the family doctor was everything to everybody, today family doctors are being pushed into more of a triage role, and they are losing their ability.
  • The problem is that the family doctor is doing everything for everybody, and probably most of their work is on the social end as opposed to diagnostics.
  • At a time when all our emergency departments are facing 15,000 increases annually, Peterborough has gone down 15,000, so people can learn from that experience.
  • The family health care team should have strong family physicians who are focused on diagnosing, treating and controlling chronic disease. They should not have to deal with promotion, prevention and diet. Other health providers should provide all of that care and family doctors should get back to focus.
  • I have to be able to reach my doctor by phone.
  • They are busy doing all of the other things that, in my mind, can be done well by a team.
  • That is right.
  • if we are to move the yardsticks on improvement, sustainability and quality, we need that alignment right from the federal government to the provincial government to the front line providers and to the health service providers to say, "We will do this."
  • We want to share best practices.
  • it is not likely to happen without strong direction from above
  • Excellent Care for All Act
  • quality plans
  • with actual strategies, investments, tactics, targets and outcomes around a number of things
  • Canadian Hospital Reporting Project
  • by March of next year we hope to make it public
  • performance, outcomes, quality and financials
  • With respect to physicians, it is a different story
  • We do not collect data on outcomes associated with treatments.
  • which may not always be the most cost effective and have the better outcome.
  • We are looking at developing quality indicators that are not old data so that we can turn the results around within a month.
  • Substantive change in how we deliver health care will only be realized to its full extent when we are able to measure the cost and outcome at the individual patient and the individual physician levels.
  • In the absence of that, medicine remains very much an art.
  • Senator Eaton
  • There are different types of benchmarks. For example, there is an evidence-based benchmark, which is a research of the academic literature where evidence prevails and a benchmark is established.
  • The provinces and territories reported on that in December 2005. They could not find one for MRIs or CT scans. Another type of benchmark coming from the medical community might be a consensus-based benchmark.
  • universal screening
  • A year and a half later, we did an evaluation based on the data. Increased costs were $400 per patient — $1 million in my hospital. There was no reduction in outbreaks and no measurable effect.
  • For the vast majority of quality benchmarks, we do not have the evidence.
  • A thorough research of the literature simply found that there are no evidence-based benchmarks for CT scans, MRIs or PET scans.
  • We have to be careful when we start implementing best practices because if they are not based on evidence and outcomes, we might do more harm than good.
  • The evidence is pretty clear for the high acuity; however, for the lower acuity, I do not think we know what a reasonable wait time is
  • If you are told by an orthopaedic surgeon that there is a 99.5 per cent chance that that lump is not cancer, and the only way you will know for sure is through an MRI, how long will you wait for that?
  • Senator Cordy: Private diagnostic imaging clinics are springing up across all provinces; and public reaction is favourable. The public in Nova Scotia have accepted that if you want an MRI the next day, they will have to pay $500 at a private clinic. It was part of the accord, but it seems to be the area where we are veering into two-tiered health care.
  • colorectal screening
  • the next time they do the statistics, there will be a tremendous improvement, because there is a federal-provincial cancer care and front-line provider
  • adverse drug effects
  • over-prescribing
  • There are no drugs without a risk, but the benefits far outweigh the risks in most cases.
  • catastrophic drug coverage
  • a patchwork across the country
  • with respect to wait times
  • Having coordinated care for those people, those with chronic conditions and co-morbidity, is essential.
  • The interesting thing about Saskatchewan is that, on a three-year trending basis, it is showing positive improvement in each of the areas. It would be fair to say that Saskatchewan was a bit behind some of the other jurisdictions around 2004, but the trending data — and this will come out later this month — shows Saskatchewan making strides in all the areas.
  • In terms of the accord itself, the additional funds that were part of the accord for wait-times reduction were welcomed by all jurisdictions and resulted in improvements in wait times, certainly within the five areas that were identified as well as in other surgical areas.
  • We are working with the First Nations, Statistics Canada, and others to see what we can do in the future about identifiers.
  • Have we made progress?
  • I do not think we have the data to accurately answer the question. We can talk about proxies for data and proxies for outcome: Is it high on the government's agenda? Is it a directive? Is there alignment between the provincial government and the local health service providers? Is it a priority? Is it an act of legislation? The best way to answer, in my opinion, is that because of the accord, a lot of attention and focus has been put on trying to achieve it, or at least understanding that we need to achieve it. A lot of building blocks are being put in place. I cannot tell you exactly, but I can give you snippets of where it is happening. The Excellent Care For All Act in Ontario is the ultimate building block. The notion is that everyone, from the federal, to the provincial government, to the health service providers and to the CMA has rallied around a better health system. We are not far from giving you hard data which will show that we have moved yardsticks and that the quality is improving. For the most part, hundreds of thousands more Canadians have had at least one of the big five procedures since the accord. I cannot tell you if the outcomes were all good. However, volumes are up. Over the last six years, everybody has rallied around a focal point.
  • The transfer money is a huge sum. The provinces and territories are using the funds to roll out their programs and as they best see fit. To what extent are the provinces and territories accountable to not just the federal government but also Canadians in terms of how effectively they are using that money? In the accord, is there an opportunity to strengthen the accountability piece so that we can ensure that the progress is clear?
  • In health care, the good news is that you do not have to incent people to do anything. I do not know of any professionals more competitive than doctors or executives more competitive than executives of hospitals. Give us the data on how we are performing; make sure it is accurate, reliable, and reflective, and we will move mountains to jump over the next guy.
  • There have been tremendous developments in data collection. The accord played a key role in that, around wait times and other forms of data such as historic, home care, long term care and drug data that are comparable across the country. Without question, there are gaps. It is CIHI's job to fill in those gaps as resources permit.
  • The Health Council of Canada will give you the data as we get it from the service providers. There are many building blocks right now and not a lot of substance.
  • send him or her to the States
  • Are you including in the data the percentage of people who are getting their work done elsewhere and paying for it?
  • When we started to collect wait time data years back, we looked at the possibility of getting that number. It is difficult to do that in a survey sampling the population. It is, in fact, quite rare that that happens.
  • Do we have a leader in charge of this health accord? Do we have a business plan that is reviewed quarterly and weekly so that we are sure that the things we want worked on are being worked on? Is somebody in charge of the coordination of it in a proper fashion?
  • Dr. Kitts: We are without a leader.
  • Mr. Abbott: Governments came together and laid out a plan. That was good. Then they identified having a pharmaceutical strategy or a series of commitments to move forward. The system was working together. When the ministers and governments are joined, progress is made. When that starts to dissipate for whatever reason, then we are 14 individual organization systems, moving at our own pace.
  • You need a business plan to get there. I do not know how you do it any other way. You can have ideas, visions and things in place but how do you get there? You need somebody to manage it. Dr. Kitts: I think you have hit the nail on the head.
  • The Chair: If we had one company, we would not have needed an accord. However, we have 14 companies.
  • There was an objective of ensuring that 50 per cent of Canadians have 24/7 access to multidisciplinary teams by 2010. Dr. Kitts, in your submission in 2009, you talked about it being at 32 per cent.
  • there has been a tremendous focus for Ontario on creating family health teams, which are multidisciplinary primary health care teams. I believe that is the case in the other jurisdictions.
  • The primary health care teams, family health care teams, and inter-professional practice are all essentially talking about the same thing. We are seeing a lot of progress. Canadian Health Services Research Foundation is doing a lot of work in this area to help the various systems to embrace it and move forward.
  • The question then came up about whether 50 per cent of the population is the appropriate target
  • If you see, for instance, what the Ontario government promotes in terms of needing access, they give quite a comprehensive list of points of entry for service. Therefore, in terms of actual service, we are seeing that points of service have increased.
  • The key thing is how to get alignment from this accord in the jurisdictions, the agencies, the frontline health service providers and the docs. If you get that alignment, amazing things will happen. Right now, every one of those key stakeholders can opt out. They should not be allowed to opt out.
  • the national pharmaceutical strategy
  • in your presentation to us today, Dr. Kitts, you said it has stalled. I have read that costing was done and a few minor things have been achieved, but really nothing is coming forward.
  • The pharmacists' role in health care was good. Procurement and tendering are all good. However, I am not sure if it will positively impact the person on the front line who is paying for their drugs.
  • The national pharmaceutical strategy had identified costing around drugs and generics as an issue they wanted to tackle. Subsequently, Ontario tackled it and then other provinces followed suit. The question to ask is: Knowing that was an issue up front, why would not they, could not they, should not they have acted together sooner? That was the promise of the national pharmaceutical strategy, or NPS. I would say it was an opportunity lost, but I do not think it is lost forever.
  • Irene Jansen on 23 Jan 12
     
    CIHI Health Canada Statistics Canada
Irene Jansen

Jeffrey Turnbull "CMA supports competition and private sector involvement in delivery" ... - 0 views

medicare.ca/okerage-gains-ground-in-canada

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  • While the CMA believes no Canadian should be denied health care because they can’t pay for it and ultimately supports the principles in the Canada Health Act, Turnbull said it also supports improving competition and involving the private sector in health care delivery.
Irene Jansen

Strengthening Health Systems Through Innovation: Lessons Learned Dec 2011 Anne Snowdon ... - 0 views

sites.ivey.ca/...althSystemsWhitePaperFINAL.pdf

health policy innovation international comparisons privatization canada

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  • Irene Jansen on 23 Jan 12
     
    Leveraging the power of consumer choice, which drives competition for health system actors to redesign and transform services to actively engage consumers in managing their personal health and wellness, will offer transformational change for the culture of health care systems in Canada.
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